Cost vs. Care?

Members are Making the Choice
COMMENTARY
November 29, 2016
Executive Vice President and Chief Operating Officer, CVS Health

Understanding how rising health care costs affect consumer decisions about obtaining care is a key part of developing cost-effective solutions that help improve health outcomes. As an enterprise, CVS Health conducts ongoing research, surveys and analysis to help identify consumer preferences which in turn inform our product offerings, including those for the pharmacy benefit clients of CVS Caremark.

In the past month affordability concerns caused 28% to put off needed care, and 21% to put off filling a prescription.

A recent CVS Health/Morning Consult poll of 2,000 registered voters reveals that consumers often put off care because of cost concerns.

In the past month affordability concerns caused 28% to put off needed care, and 21% to put off filling a prescription.

The survey revealed that among consumers 18-29 years of age these concerns have a much greater impact. Four out of 10 survey respondents in that age group said they put off needed medical care in the last month. One-in-three between the ages of 18 and 44 put off filling a prescription due to cost concerns.

Interestingly, those over 65 years old were significantly less likely to have put off needed care – only 14 percent of respondents indicated having done so.

Solutions That Address Both Member and Payor Needs

Leveraging our deep understanding of consumer behavior as a result of such surveys and analyses, we at CVS Caremark develop and implement solutions for our clients and their members that help reduce overall costs while helping to improve health outcomes.

One big challenge from a cost as well as outcomes perspective is members dropping off therapy after first fill or becoming non-adherent later. Non-adherence costs the nation an estimated $300 billion a year and nearly 50 percent of patients drop off chronic medication therapy in the first year. Through Pharmacy Advisor, pharmacists can consult with members and understand their concerns about therapy, including cost. They can help find lower cost alternatives that can help ensure a member stays on therapy and reduce the cost burden on the member as well as the plan.

We also offer plans with the ability to adopt our preventive medication list. This allows for coverage of certain medications prior to satisfaction of an individual’s deductible under a qualifying high-deductible health plan at no cost or at the plan’s applicable copay.

Another program, widely adopted by our clients, is Drug Savings Review (DSR), which includes dose optimization. DSR helps maximize savings and improve clinical outcomes while minimizing member disruption. DSR identifies opportunities for improved prescribing and utilization for prescriptions filled at both mail and retail according to accepted evidence-based prescribing criteria.

DSR provides concurrent and retrospective reviews of prescription drug claims for:

  • Age appropriateness
  • Therapeutic alternatives
  • Contraindications
  • Optimal dose
  • Duplicate therapy
  • Optimal duration

  • Age appropriateness
  • Therapeutic alternatives
  • Contraindications
  • Optimal dose
  • Duplicate therapy
  • Optimal duration

Leveraging Technology for Cost Tracking, Savings

We offer various tools on our member portal — Caremark.com — to check drug cost, track prescription spending and find lower-cost, clinically-equivalent alternatives.

Our new Integrated Customer Experience dashboard, which is expected to be rolled-out to pharmacy benefit clients by second quarter of 2017, will enable members to track all their prescriptions and prescription spending across channels in one place. It also allows members to manage and refill all their prescriptions through one channel at one time.

Cost Is Not Everything

29% shop around for health care providers, and 67% of thos select care based on their research

Our survey found that consumers are focused on quality of care. When seeking a health care provider, 52 percent say quality of care is the most important factor in considering whom to see, followed by trusted advice (17 percent). In addition, 29 percent shop around for health care providers and services “Always” or “Sometimes.” Of this group, 67 percent “Regularly” or "Sometimes" select care based on their research.

29% shop around for health care providers, and 67% of thos select care based on their research

MinuteClinic, which has had 30 million patient visits in 1,100 locations, has a 95 percent customer satisfaction rating. Similarly, 95 percent of patients were highly satisfied with CVS Health’s telehealth service provided through the partnership with American Well, Doctor on Demand and Teledoc.

MinuteClinic offers high-quality affordable health care seven days a week, including evenings and weekends.

At CVS Health, we have invested in and built the infrastructure to support improved interventions in every channel. Our focus is on continuously evolving and improving our products and services and leveraging our enterprise model to help ensure clients and their members are getting high quality care at the lowest net cost.

How can you control costs for both your plan and your members? Ask Us
COMMENTARY
November 29, 2016
Executive Vice President and Chief Operating Officer, CVS Health

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